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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629139
Report Date: 10/04/2021
Date Signed: 10/04/2021 03:27:52 PM

Document Has Been Signed on 10/04/2021 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MARTINEZ SIERRA, MA FAMILY CHILD CAREFACILITY NUMBER:
376629139
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/04/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ma Magdalena Martinez SierraTIME COMPLETED:
03:30 PM
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On October 4, 2021 at 1:30PM, Licensing Program Analysts (LPAs) Gloria Gonzalez and David Miller conducted a pre-licensing inspection with Applicant Ma Magdalena Martinez Sierra. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The Applicant provided LPAs with entry into her home. Present in the home was the Applicant, her husband, Jorge Sanchez, and two children. This is a four bedroom, two-and-a-half (2.5) bathroom, two (2) story home was toured and inspected. The daycare operational schedule will be weekdays from Monday through Friday from 6:00am to 6:00pm.

Applicant will use the following areas for childcare: Living Room, kitchen, downstairs bathroom, and backyard. The off limits areas include: all upstairs, (which include four bedrooms upstairs, two bathrooms), and the garage. and are made inaccessible to day care children by use of safety gates and door knob covers. The rooms and bathrooms upstairs also have locks on the door and door knob covers. Applicant stated there are no bodies of water present on the premises; and LPA observed that there is no bodies of water during time of inspection. The fire extinguisher is rated 3A 40B: C and located in the kitchen; mounted on the wall. The smoke and carbon monoxide detectors meet requirements and are operational and are located in the living room and the fire alarm is located in the bathroom hallway. Applicants was advised to keep any poisons shall be locked and made inaccessible to children. Applicant stated that detergents, and cleaning compounds are secured inaccessible to children in care by high placement in the bathroom closet which is made inaccessible to children’s.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ SIERRA, MA FAMILY CHILD CARE
FACILITY NUMBER: 376629139
VISIT DATE: 10/04/2021
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Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Medicines are in an upstairs room stairs stored in a locked closet and stored on a top shelf inaccessible to children. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant agreed to notify licensing should her telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home.

The Applicant intends to conduct outdoor activities in the fenced backyard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges children shall never be left unattended in any vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ SIERRA, MA FAMILY CHILD CARE
FACILITY NUMBER: 376629139
VISIT DATE: 10/04/2021
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Applicant is advised to regularly visit the Community Care Licensing WEB Site: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.

Southern California Child Care Advocate information was provided : (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov Applicant was encouraged to subscribe through the CCLD website in order to be placed on the email list for updated regulation information.
Please visit the Guardian webpage and set-up your Guardian account: https://cdss.ca.gov/inforesources/cdss-programs/community: care-licensing/caregiver-background-check/guardian

The new provider and resource packet was provided to the applicant; including information on the following: LEAD Exposire, SIDS, shaken baby, child abuse/reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log and discussed California’s Megans Law and LPA provided the following: www.megans/law.ca.gov. Applicant was also informed the following items are prohibited during the operating hours (walkers, exersaucers, jumpers and bouncy seats). LPA conducted technical support to provide the applicant information regarding the COVID-19 disease. Corporal punishment and smoking are not allowed in the day care.

LPAs discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months or six children with no more than three infants; or with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age sex, including children under age 10 who live in the home.

The following pending issues are needed prior to the issuance of the license:

Negative TB test result for Mercedes Medina shall be provided to the department
Criminal Record Clearance for Mercedes Medina

Exit interview conducted and report was reviewed with the Applicant Ma Magdalena Martinez Sierra. LPA Gloria Gonzalez interpreted and explained this report in Spanish. Applicant stated that she understood the information provided in this report.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC809 (FAS) - (06/04)
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